Global challenges in AD care

What were the gaps and challenges in AD care across the patient pathway?

A number of gaps in care exist across the patient pathway

Awareness and Presentation Symptom presentation

Gaps in care

  • Misconceptions regarding the causes and triggers of AD (especially the role of allergies)(a)

Challenges driving gaps in care


  • AD having no clear cause, making it difficult to explain and prone to misconceptions(a)
  • Physicians may have received limited education regarding AD(b)


  • Experience of stigmatisation (similar to other visible skin diseases) e.g. due to the misconception AD is contagious(c)
  • AD is underappreciated as it is seen as a childhood disease that causes minor problems(c)

Diagnosis and Referral In secondary and tertiary care

Gaps in care

  • Delayed referral and access to AD specialist care (when required)(d)

Challenges driving gaps in care

Health Systems

  • Healthcare systems or insurance requiring a primary care practitioner (PCP) referral to access specialist AD care(e)
  • Variation in technological infrastructure that can create inefficient referral processes(e)
  • Lack of dermatologists and expanding centre catchment areas/growing populations resulting in increasing demand(e)


  • AD patients commonly presenting to PCP(f), who may have received limited training on AD management and referral(d), and exposure to new treatments available in specialist care(g)
  • There being a number of diseases that may mimic AD and atypical AD presentations that can lead to misdiagnosis(h)
  • It being challenging to determine AD severity(i), and that each patient is individual in how they are affected by the disease(a)

Treatment and Management Medical and non-medical management

Gaps in care

  • Lack of patient access to AD treatments(j)
  • Patient non-adherence to treatment regimens(k)

Challenges driving gaps in care

Health Systems

  • Fixed budgets/resources means reimbursement is not always available for certain treatments(j)
  • Medical insurance coverage for certain treatments will vary across providers/plans(l)
  • Fewer AD treatment options are available for paediatric populations (e.g. not yet approved)(m)


  • Lack of patient education delivered regarding correct dosage/usage and appropriate treatment expectations(j)
  • Short consultations can limit time available for patient education(n)


  • Significant burden of treatment application for patients/carers(k)(p)
  • Fear of treatment side-effects (e.g. corticosteroid phobia from misinformation)(o)
  • Financial burden of AD treatment, which can impact access(k)(p)

Follow-up Monitoring of chronic disease/flare up

Gaps in care

  • Managing of the complexity of AD as a disease and its comorbidities(d)
  • Reducing the burden of AD on patients(k)(p)

Challenges driving gaps in care

Health Systems

  • Limited availability or access to (e.g. due to funding) comorbidity specialists/multidisciplinary team (MDT) to help provide holistic AD care(d)(q)


  • Individual trigger factors differ(i)(r), and the fluctuating nature of disease causes change over time(s), resulting in requirements for individual tailoring of information and advice
  • Association of AD with multiple comorbidities/conditions, each of which may require specialist help to be diagnosed and managed effectively(d)


  • Impact of AD on multiple components of patients’ QoL (mental well-being, sleep, relationships, finances, work/school, etc.)(t)(u)
  • Chronic nature of AD requiring lifelong patient management(j)


Lee J, et al. A Comprehensive Review of the Treatment of Atopic Eczema. Allergy Asthma & Immunology Research. 2016;8(3):181-190. doi:10.4168/aair.2016.8.3.181


Kownacki S. Skin diseases in primary care: what should GPs be doing? Br J Gen Pract. 2014;64(625):380–381. doi:10.3399/bjgp14X680773


Simpson EL, et al. Association of Inadequately Controlled Disease and Disease Severity With Patient-Reported Disease Burden in Adults With Atopic Dermatitis. JAMA Dermatol. 2018;154(8):903–912. doi:10.1001/jamadermatol.2018.1572


Allergy UK and Sanofi Genzyme. Seeing Red: Getting under the skin of adult severe eczema. 2017 [Website] Accessed 22 Oct 2019


The U.S. Health Care System. The Commonwealth Fund [Website] 22 Oct 2019


Abuabara K, et al. Prevalence of Atopic Eczema among patients seen in primary care: data from the Health Improvement Network. Ann Intern Med. 2019;170(5):354-365. doi:10.7326/M18-2246


Le Roux E, et al. GPs' experiences of diagnosing and managing childhood eczema: a qualitative study in primary care. Br J Gen Pract. 2018;68(667):e73–e80. doi:10.3399/bjgp18X694529


Siegfried E, et al. Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications. J Clin Med. 2015;4(5):884-917. doi: 10.3390/jcm4050884


Silverberg JI, et al. Assessing the severity of atopic dermatitis in clinical trials and practice. Clin Dermatology. 2018;3695):606-615. doi: 10.1016/j.clindermatol.2018.05.012


International Alliance of Dermatology Patient Organizations. Atopic Dermatitis: A collective Global Voice for Improving Care [PDF] Accessed 1 Oct 2019


Drucker AM, et al. The Burden of Atopic Dermatitis: Summary of a Report for the National Eczema Association. Journ of Invest Derm 2017;137(1):26-3


Working with your Health Insurance. National Eczema Association [Website] 9 Nov 2019


Hajar T, et al. New and developing therapies for atopic dermatitis. An Bras Dermatol. 2018;93(1):104–107. doi:10.1590/abd1806-4841.20187682


Mehta S. Patent Satisfaction reporting and its implications for patient care. AMA Journal of Ethics. 2015;17(7):616-21. doi: 10.1001/journalofethics.2015.17.7.ecas3-1507.


Hajar T, et al. A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol. 2015;72(3):541-549.e2. doi: 10.1016/j.jaad.2014.11.024


Silverberg JI. Health Care Utilization, Patient Costs, and Access to Care in US Adults With Eczema: A Population-Based Study. JAMA Dermatol. 2015;151(7):743–752. doi: 10.1001/jamadermatol.2014.5432


LeBovidge J. Multidisciplinary interventions in the management of atopic dermatitis. The Journal of Allergy and Clinical Immunology. 2016;138(2):325-334. doi: 10.1016/j.jaci.2016.04.003


Dhar S, et al. Food allergy in Atopic Dermatitis. Indian J Dermatology. 2016;61(6):645-648. doi: 10.4103/0019-5154.193673


Clausen ML, et al. Skin Barrier Dysfunction and the Atopic March. Curr Treat Options Allergy (2015) 2:218-227. doi: 10.1007/s40521-015-0056-y


Simpson EL, et al. Association of Inadequately Controlled Disease and Disease Severity With Patient-Reported Disease Burden in Adults With Atopic Dermatitis. JAMA Dermatol. 2018;154(8):903–912. doi:10.1001/jamadermatol.2018.1572


Aubert H, et al. Non adherence and topical steroids. Ann Derm Ven. 2012;139(1):Suppl1:S7-12. doi: 10.1016/S0151-9638(12)70102-3